The fascia lata, or the deep fascia of the thigh, is an especially strong fascial sheath which envelops the thigh like a sleeve. Lata is Latin for 'broad' meaning that this fascia encloses a wide area of the thigh region.
The fascia lata wraps the large muscles of the thigh and forms the outer limit of the fascial compartments. In doing so, it limits the outward expansion of contracting muscles, making muscular contraction more efficient in compressing veins to push blood towards the heart.
The deep aspect of the facia lata gives off three fascial intermuscular septa that divide the thigh muscles into three separate compartments: anterior, medial and posterior.
This article will describe the anatomy and function of the fascia lata.
|Definition||Deep fascia of thigh which surrounds the muscles of the thigh|
Anterior: Inguinal ligament, pubic arch, body of pubis, pubic tubercle
Superior: Scarpa's fascia
Posterolaterally: Iliac crest
Posteromedially: Sacrum, coccyx, sacrotuberous ligament, ischial tuberosity/ischiopubic ramus
Distal femur, tibia, crural fascia
Arteries: Superficial circumflex iliac artery, superficial epigastric artery, superficial external pudendal artery
Veins: Perforating veins of great saphenous vein
Nerves: Ilioinguinal nerve, femoral branch of genitofemoral nerve, medial, intermediate and lateral femoral cutaneous nerves, cutaneous branch of obturator nerve
Lymphatics: Vertical group of lymph nodes
|Function||Limits outward expansion of contracting thigh muscles, aids venous return from lower limb, provides stability to knee joint in extended and partially flexed positions (through iliotibial tract)|
- Gross anatomy
- Anatomical relations and attachments
- Clinical application
The fascia lata is thickened and strengthened laterally by reinforcing longitudinal fibers which contribute to the formation of a thick band of fascia known as the iliotibial tract. The iliotibial tract is a 2cm broad, thick fibrous band of the lateral aspect of the thigh. Superiorly, this tract is composed of two layers and encloses two muscles: the tensor fasciae latae and gluteus maximus muscles. Inferiorly, the two layers merge into a single thickened sheet called the gluteal aponeurosis, shared between these two muscles. The iliotibial tract extends from the iliac tubercle to the anterolateral tubercle of the tibia (also called the Gerdy tubercle) and aids in stabilizing the knee joint.
The fascia lata contains an oval opening or hiatus known as the saphenous opening or the fossa ovalis through which the great saphenous vein and efferent lymphatic vessels of the superficial inguinal lymph nodes pass through. The saphenous opening is inferior to the medial part of the inguinal ligament, approximately 4 cm inferolateral to the pubic tubercle. The opening is bounded inferolaterally by the sharp crescentic margin, known as the falciform margin. The medial margin of the opening lies at a deeper level and is formed by the fascia overlying the pectineus muscle. Joining the medial margin of the saphenous opening is another sheet of fascia known as the cribriform fascia. This sieve-like layer of fascia spreads over the saphenous opening, closing it. Structures which pass through the saphenous opening, pierce the cribriform fascia as they travel to reach their destination.
Find out more about other fascial structures of the hip and thigh by checking out this article.
Anatomical relations and attachments
The fascia lata attaches and is continuous with:
- Anterior: The inguinal ligament, pubic arch, body of pubis, and pubic tubercle.
- Superior: The membranous layer of subcutaneous tissue or superficial fascia (Scarpa's fascia) of the inferior abdominal wall.
- Posterolaterally The iliac crest.
- Posteromedially: The sacrum, coccyx, sacrotuberous ligament, and ischial tuberosity/ischiopubic ramus (branch).
The inferior attachments and continuations of the fascia lata are as follows:
- The fascia lata is attached to the exposed parts of the bones which contribute to the formation of the knee: the condyles of the femur and tibia, the head of the fibula, and the sides of the patella.
- The fascia lata is also attached to the deep fascia of the leg, inferior to the knee joint. This deep fascia of the leg is called the crural fascia (crural is derived from the Latin word crus, meaning leg). The crural fascia is the distal continuation of the fascia lata.
The fascia lata receives its arterial supply from a number of arteries which traverse this area.
The fascia lata is pierced and supplied by the superficial circumflex iliac and superficial epigastric arteries. The superficial external pudendal artery traverses the saphenous opening of fascia lata and therefore also contributes to its arterial supply.
The venous return of the fascia lata include the perforating veins (accompanying the superficial circumflex iliac artery, superficial epigastric artery, and superficial and deep external pudendal arteries) of the great or long saphenous vein. Accompanying veins like these are referred to in Latin as venae comitantes.
The lymphatic drainage of the fascia lata is achieved by lymph vessels which empty into the vertical group (one of the three groups of lymph nodes of the lower limb) of lymph nodes lying lateral to the termination of the great saphenous vein.
As a general rule, deep fasciae receive their nerve supply from overlying skin. Hence, the terminal branches of some of the nerves innervating the thigh, especially those running to the skin of the thigh and pelvic regions, also innervate the fascia lata. Nerves which innervate the fascia lata include: the ilioinguinal nerve, the femoral branch of the genitofemoral nerve, the femoral cutaneous nerves and the cutaneous branch of the obturator nerve.
All of those nerves also pierce the fascia lata to supply the overlying skin. For example, the cutaneous branch of the obturator nerve supplies the area of skin above the medial side of the knee after piercing and innervating the fascia lata.
The fascia lata is described as an elastic stocking as it encompasses and surrounds the muscles of the thigh directly under the skin. It functions to limit the outward expansion of contracting thigh muscles and aids venous return from the lower limb.
The lateral thickening of the fascia lata, the iliotibial tract functions to provide stability to the knee joint in extended and partially flexed positions.
The fascia lata has been reported to be a major source of fascia used for reconstruction surgery, for example in the management of ptosis of the upper eyelid.
Trauma to muscles and/or vessels in the compartments of the thigh or leg can lead to compartment syndromes characterized by hemorrhage, edema, and inflammation of the muscles.
As the fascial compartments of the lower limbs are generally closed spaces, ending proximally and distally at joints, and the deep fascia (fascia lata or crural fascia) and septa forming the boundaries (external limits of the fascia compartments) are strong, the increased volume, consequent to the trauma, increases the intracompartmental pressure.
Thus, fasciotomy is usually performed to relieve the pressure in the compartment(s) concerned. A fasciotomy is simply the incision of an overlying fascia or septum, usually to relieve the pressure in a fascial compartment.
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